Cholera toxin has been shown to have adjuvant effects in multiple different systems. The dose, timing and genetic background of the recipient all seem to be important variables. The role of the two subunits in both the immunogenicity and the adjuvanticity of this molecule remain unclear. The mechanisms of the adjuvant effect likely involves effects on regulatory T cells; there is evidence that the adjuvant effect is due at least in part to inhibition of suppressor T cells. When KLH is used as a model antigen, the adjuvanticity of cholera toxin appears to be related to its immunogenicity in that both properties occur mainly in mouse strains that are high responders to cholera toxin. The genetic engineering of chimeric neoantigens consisting of cholera toxin subunits coupled to antigens of interest has been shown to be technically possible and is an attractive future approach for the generation of effective oral vaccines.